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Botswana

Teen centres provide a refuge for adolescents living with HIV in Botswana

'The State of the World's Children 2011 – Adolescence: An Age of Opportunity,' UNICEF’s new flagship report, focuses on the development and rights of more than a billion children aged 10 to 19 worldwide. This series of stories, essays and multimedia features seeks to accelerate and elevate adolescents' fight against poverty, inequality and gender discrimination.

By Shanta Bloemen

GABORONE, Botswana, 23 March 2011 – A first kiss for teenagers is often awkward but heavily romanticized in the recounting. But for Katlego, an energetic and cheerful 18-year-old, it is a painful memory of trust betrayed.

VIDEO: UNICEF's Eva Gilliam reports on teen centres for adolescents living with HIV in Botswana.
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She was at a family party when a boy kissed her. In her excitement, she told her cousin, one of the few people she had trusted with news of her HIV status. The next thing she remembers was the boy’s mother shouting and accusing her of spreading HIV germs to her son.

“One of the hardest aspects is thinking you have someone you can trust and then to be stabbed in the back,” says Katlego, who has just finished high school in Gaborone, Botswana’s capital city.

Katlego tested positive for HIV when she was 11. She had become infected as a result of mother-to-child transmission.

She is one of an estimated 2,000 teenagers in Botswana too old to have participated in the country’s national programme to prevent mother-to-child transmission (PMTCT) of HIV, which began in 1999.

Since then, Botswana – the first country in the region to scale-up PMTCT services on a national level, and the first in sub-Saharan Africa to reach more than 80 per cent coverage for such services – has seen a reduction of deaths in children under the age of five.

The PMTCT programme now has a more than 90 per cent coverage rate, and aims to reduce the risk of children becoming infected during pregnancy, delivery or breastfeeding even further.

HIV stigma

For teenagers like Katlego, who discover their HIV status when entering adolescence, coming to terms with their HIV status and learning how to cope with a daily regime of medicine for life can be tough.

Then there’s the stigma. Even in a country such as Botswana, which – at almost 25 per cent – has one of the world’s highest rates of HIV prevalence, discrimination is rife. There is an estimated 16,000 children under the age of 14 living with HIV.

Katlego is now taking on the stigma of HIV. She speaks out about teenagers living with HIV as a way to combat discrimination. Her confidence to take on the role has come through participating in a teen club for HIV-positive adolescents in Gaborone, Botswana.

“I don’t blame people for being scared of HIV. It scares me and I can understand that,” says Katlego. “Nobody should wish to have this virus and be linked to a life-long disease.”

The Government of Botswana estimates more than 4,000 teenagers will need anti-retroviral treatment, which helps prevent the virus from multiplying inside the body, over the next couple of years.

Teen clubs

These days, Katlego is taking on the stigma of HIV, speaking out to help diminish people’s fears. Her confidence to speak up has come through participating in a teen club for HIV-positive adolescents.

The Botswana-Baylor Children’s Clinical Center of Excellence started a teen club six years ago to tackle the growing number of HIV-positive teenagers who needed emotional and psychological support in addition to medical treatment.

Katlego says the club is vital. “Instead of reminding you that you are HIV-positive, it does just the opposite,” she says. “It makes you forget about HIV and makes you feel happy about life, seeing peers who share the same experiences that you do.”

Katlego is grateful for the teen club for HIV-positive adolescents run by the Botswana-Baylor Children’s Clinical Center of Excellence in Gaborone, Botswana. There is an estimated 16,000 children under the age of 14 living with HIV across the country.

She now dedicates much of her free time to speaking at public events as a voice of teens living with HIV and about the need to expand the work of the club.

“As more children survive and live longer, we need to cater to this group of adolescents who are dealing with their own set of issues and also physically in transition,” explains Michael Tolle, Associate Director of the Botswana-Baylor facility.

Focus on adolescents

Dr. Tolle thinks children have the right to know of their HIV status as soon as possible to avoid being shocked with the news years later.

He also thinks children feeling comfortable enough to disclose their HIV status and medical treatment adherence are closely linked. “Depression can make their adherence less than optimal, so having a support network that knows their status can be critical to how well they are doing physically,” says Dr. Tolle.

The teen club concept is catching on and is also helping to inform government efforts in providing services for adolescents.

“My hope is that the experience we are learning from Baylor will become part of the public health system and part and parcel of response,” says Dr. Haruna Jibril, Paediatric Clinical Advisor for the Department of HIV and AIDS within the Ministry of Health. “Now with few children being born positive, we have to cater to those teenagers who are growing up. “

It’s certainly helped Katlego. “When I first came here, I saw people being cheerful and happy,” she says, “I really saw the potential of having a safe environment for young people like me to interact and feel that we were not alone.”